Bright Smiles

The main objective in treating gum disease (periodontal disease) has changed from surgical intervention to plaque and calculus removal and managing a patient’s oral hygiene. This starts with a ‘periodontal charting’ (technically called the CPTIN) and detailed instruc­tions in oral hygiene, tooth brushing, flossing, etc. The chart is used to compare the pocketing after 6 weeks then at intervals of 3 months. If the oral hygiene has improved and, as a consequence, pocket depth has

Scalings

Scalings are done by a dentist or a dental hygienist, using either ultrasonic or hand scalers, or both. Removal of gross calculus from the teeth in the mouth is straight­forward, if time-consuming. Removing calculus entirely from beneath the level of the gums is a delicate matter. It can be uncomfortable, especially if there is exposed dentine on some of the teeth. To do this when advanced gum disease is present can be slow (no more than four teeth in a session) and may require a local anaesthetic. It is, however, a vital procedure, and is worth the dis­comfort. Without removing this deep calculus, the chances of arresting pocket formation, and so saving the teeth, are very slim.

Root planing

In essence this is scaling the length of the root within a pocket to remove calculus.

Gingivectomy

This is an operation to improve access to the surface of the tooth by removing the wall of the pocket (i.e. part of the gum itself). It allows for proper cleaning. The area is ‘packed’ with a gauzy dressing until healed. Gingivoplasty, which involves recontouring the gums, is a similar operation. Neither operation is done as often as in the past, partly because they were less than totally successful, and partly because the treatment of choice is now the management of the patient’s plaque.

Surgery

This involves cutting the gum above (or below) the tooth and peeling it back to expose the bone, and the side and root of the tooth (if there is a deep pocket). This is called a surgical flap. The area is then scaled and cleaned. The gum is sutured in a slightly different position, exposing more of the tooth and allowing better access to this area for cleaning. It is possible to use bone chips in an attempt to get bone regeneration and/or go on a local antibiotic regime by packing the pocket with antibiotic gel or cord.

Splints

This treatment involves the use of a healthy tooth to stabilize an unstable one. It uses the same principle as strapping two fingers together to protect a broken one. This can be done with wires, Maryland technique or composite filling material.

Occlusal equilibration

This is intended to even up the biting pressure on teeth, so relieving the most vulnerable teeth, and /or stresses on the tempero-mandibular joint (TMJ), or jaw joint. It is done by getting the patient to chew on pieces of colored paper. These leave marks on the teeth where they strike first. The teeth are ‘eased’ in those places. The same technique is used to adjust inlays, crowns, bridges and dentures.

Root extraction

If the gums recede so far on some back teeth, naturally, or as a result of one of the above treatments, a root may be very exposed in the mouth. One root of a three-rooted tooth may need to be extracted – amputated would be a better description.